[WorriedInNYC]

Long story, here it goes.

I suffered a concussion exactly six years ago. I got hit on the top of the head by a cell phone that was thrown in the air. I never lost consciousness or felt dizzy or anything like that but in the days following I showed classic concussion symptoms.

I went to a neurologist who officially diagnosed me with a mild concussion.

The initial symptoms took about a month to clear and within six months I would say I was fully recovered.

That’s where the real problems began.

I became hyper sensitive to any touch to the head or startle in general. If I didn’t get a full nights sleep I couldn’t function because I felt like my brain was going to be compromised.

I saw a different neurologist and she passed these off as anxiety. I said alright and went about my life, still trying to navigate around these symptoms.

This continued for about 2-3 years until a particular incident where I got into a loud argument with a relative. The argument lasted about 30 minutes and afterward I felt like I was on another planet. The startle response was unlike anything I’d ever experienced. Usually it would resolve itself within a few hours, this time it took me literally a month to start feeling like myself again.

Ever since, the slightest bit of startle has caused me worlds of difficulty. The most minute thing sets me off.

After about a year of this, I finally had enough and said F it, whatever happens happens. I stopped being so cautious about everything and got two jobs, including one as a summer camp counselor. Everything was pretty good up until the very end of the summer when a co worker went to yell at a child and ended up doing so right in my ear.

I got the same exact feeling I had with the argument with the relative, only this time it was worse. I tried to fight through for about two days until it was absolutely unbearable. It was at this point my brain “shut down” and I had trouble communicating for almost a week. I could think of words to say but as soon as I attempted to actually dictate them I could never get more than a sentence out at a time. Thank goodness this eventually subsided but I was again stuck in the cycle of avoidance.

Fast forward to October, right before my birthday. I had started feeling better again when one day in the shower I poked myself in the head while washing my hair. This had happened before and I had trained myself not to overreact. Sounds were my main problem, not actual touches.

So I went to bed and felt fine the next day. However, the following day I had a searing headache right in the spot I poked, and it was immensely exacerbated by any use of my right hand. Throughout my PCS, headaches were something I had never gotten, oddly enough.

After a few days of laying in bed unable to do anything, I set up an appointment with another neurologists, this time one in Manhattan. Manhattan is home to some of the best doctors in the world and this guy was considered top class. I explained to him my situation and he said it’s highly unlikely that all these symptoms are actually related to the concussion and most likely they’re all anxiety related.

He ordered a wide array of test. CAT Scan, MRI with contrast, EEG, EKG, ultrasound, blood and urine. They all came back clean, exemplary in fact. So he diagnosed it as general anxiety disorder and advised me to see a shrink.

It was around this time that the headaches started to subside. I felt better and was excited about the holidays. Until a week ago.

I was walking home from my local mall carrying a bag of Christmas presents when about halfway through I got that headache again. Furthermore, when I got home my relatives were playing very loud music, something that initially was a trigger but I had learned to deal with.

The combination of the two sent me back to a shell. Luckily, it subsided within about two days until after helping someone move some chairs, it returned.

It seems like carrying things is a trigger.

What I simply cannot understands is if all this is indeed startle response, why the headache? The headache was not a symptom of the initial concussion so why would it present itself now? And why in the exact spot that I poked myself?

I’m having great difficulty even typing this, as the trigger with my hands, specially my right is back in full force. The headache is also concentrated on the right side of my head.

The only relief I can seem to get is when I press down on the area outside my ear that connects the ear to the jaw. A nerve is located here which leads me to believe it may be a nerve issue, but then why would it be triggered by a poke and lifting?

The whole thing makes little sense and is incredibly frustrating. The intitial impact was mild and so long ago, why do these things keep happening?

I just want to get on with my life. Any tips would be greatly appreciated.

Thank you.

[Mark in Idaho]

WorriedinNYC,

Welcome to Neurotalk.

It sure sounds like you are struggling with some serious anxiety issues with a dose of PTSD from your years of anxiety. You may have taught yourself to respond to these stimuli over the years.

I agree with the neuro. You should seek out a therapist. A neuropsychologist might help to start but a good therapist who can teach you Cognitive Behavioral Therapy CBT techniques to manage these triggers and symptoms will likely be the key.

The brain can memorize response symptoms and play them back with a slight trigger. Think of it as a sort of flashback.

You may need some meds, an SSRI or SNRI or such to help you settle down while you learn these needed skills.

Christmas is a very stressful time for people with these issues. I can't imagine how much more stressful Christmas is in Manhattan. Woooooh.

I bet that cell phone event was very traumatic. You were startled, annoyed, angry and more and those emotions ruminated for quite some time leading to your symptoms. You are repeating this cycle with the shouting match and the head poke.

A therapist can help with both CBT and exposure conditioning. Exposure to the triggers with preplanned responses until you can be mildly surprised with the trigger and still manage a proper response. Eventually, you can learn to tolerate more startling triggers.

This may take many months. You have years of habits to undo.

I would encourage you to write a note on a slip of paper and keep it in your wallet/purse or at a note on your smart phone. I carry these slips in my wallet that reads,

"Please be patient with me. I suffer from a brain injury that causes me to over-react when confronted with shouting or someone barking orders. I respond by getting loud. Any assistance to help limit excessive auditory stimulation is helpful."

You can write a statement that fits your needs. I print a dozen copies the size of business cards so I can hand a copy to the person. They will read the note better if you are not holding it. I let them keep it so they may read it again and realize there are people like us who need their understanding and help.

I've been denied boarding a flight because the TSA agent yelled at me from behind as I was trying to put my stuff on the conveyor and I reacted by yelling back, 'What do you want?'

Cops can also get loud.

Please feel free to lean on us. We have heard it all.

My best to you.

[WorriedInNYC]

Hi Mark, thanks for the response.

I'm actually fine when I don't have a trigger. I don't lash out or anything of that sort. And Chirstmas is typically a time I love.

What I simply cannot understand is the headache. There is zero chance the tap caused any kind of impact, and if it was some sort of PTSD, why would a symptom that never presented itself initially appear now?

That's the frustrating thing.

I don't have the time to wait for these things to pass like I used to. There's nothing wrong with my brain. It was a mild concussion six years ago.

So how do I rid myself of this headache?

[Mark in Idaho]

Yes, Christmas is a time to love. But, it is also a time of extreme levels of sensory stimulation, planning, juggling activities, etc. These all heighten how the brain responds and remembers symptoms. I have learned to become almost a shut-in during this time. I can moderate my exposure by avoiding busy and loud environments and staggering activities so they are not back to back.

Your comment "I became hyper sensitive to any touch to the head or startle in general. If I didn’t get a full nights sleep I couldn’t function because I felt like my brain was going to be compromised." is often repeated here. Those who get caught in this mindset also have similar experiences to you.

The shower poke was just enough sensation to trigger the memory of those past symptoms and thoughts. As you say, when you are not triggered, you can do fine. Time can help these memorized responses fade away until another over-load resets the clock.

Some of us have rescue meds to help us settle down after an overload. I have some clonazepam and propranolol that I can used, depending on the type of response I have. I may use one once a year or so but when I do, it is a lifesaver. I know how important it is to break the thought cycle.

A concept to remember is the brain remembers thing, almost to an engraved in stone level, when those things happen under stress.

The basic idea is we get in a battle with our minds. Identifying the opposition is important. That opposition is not the bump or sharp touch. It is the memorized symptoms the brain throws at us with these minimal triggers. It can be even worse if the trigger causes us to check for symptoms. Checking for symptoms is an almost guarantee of those symptoms manifesting.

Some will start with simple concussion symptoms that are prolonged so they start researching concussion. All of a sudden, other symptoms start manifesting based on the the suggestions they got in their research. The concussed and anxious mind can do tricks on us. The Concussion movie a few years ago added anxiety to many who have suffered concussions.

Do you have access to a home blood pressure kit. The bit of anxiety can cause an elevated blood pressure that can contribute to headaches. This is why I have the rescue propranolol.

If you can moderate and weather the next week and get past New Years, I bet things will settle down. But, it is still worthwhile to work on getting help to resolve the chance of repeating this cycle. Accepting that these responses are real and you are not going crazy or something can help to move toward understanding how to moderate them.

I hope this helps.

My best to you.

[Lebber]

Hey worriedinNYC, a young neuropsych here. Although nobody can tell for sure, it really sounds like ptsd. There is a possibility that the headaches can be triggered by a physical stress response. Headaches often stem from overly tense muscles which can be triggered be stress. It's a fight/flight reaction of our body.

Do you sometimes have difficulting to come up with words during these episodes? Difficulty with that is a very common sign of ptsd. Scientist thinks that in times of psychological trauma our verbal memory shuts down. So in stead of verbalizing the trauma you start to feel it, relieve it. The trauma is stored in the sensorial parts of our memory.
Ptsd is nowadays seen as a problem in memory storage and can be often succesfully treated with certain techniques like eye movement desentization.

Toghetter with a psychologist you can explore why sounds trigger it. Why little bumps trigger it is more obvious, but the question lays in why sounds does that do. Finding out why isn't easy, but it's important to find the root of pstd.

My best of luck

[Lebber]

@Mark. Don't want to go against you. Because all the advise you give is very good. You have alot of insight in this. And i personally find exposure a very good therapy. But from what i can read so far exposure in vivo would be to soon. I would recommend rescripting first with progressive relaxation first. Then imaginary exposure before doing exposure in vivo because it can retraumatize someone if done too soon. As long as the trauma isn't rescripted in the mind the triggers will stay. And people need to learn to cope with episodes first before doing exposure.
Older textbooks did dictate doing immediate exposure as soon as possible after trauma but now research shows that it is just retraumatizing people.

[Mark in Idaho]

WorriedinNYC,

As I said, "A therapist can help with both CBT and exposure conditioning. Exposure to the triggers with preplanned responses until you can be mildly surprised with the trigger and still manage a proper response. Eventually, you can learn to tolerate more startling triggers."

By preplanned responses, I am referring to thought responses that have been practiced before any exposure to the touches or other stimulations. It should be a gradual process. As I said, it can take months to overcome the memorized over-anxious responses. Progressing slowly is important because people like us do not tolerate intense therapies very well.

I hope you can find that specialist after the New Year.

My best to you.

[WorriedInNYC]

Originally Posted by Lebber

@Mark. Don't want to go against you. Because all the advise you give is very good. You have alot of insight in this. And i personally find exposure a very good therapy. But from what i can read so far exposure in vivo would be to soon. I would recommend rescripting first with progressive relaxation first. Then imaginary exposure before doing exposure in vivo because it can retraumatize someone if done too soon. As long as the trauma isn't rescripted in the mind the triggers will stay. And people need to learn to cope with episodes first before doing exposure.
Older textbooks did dictate doing immediate exposure as soon as possible after trauma but now research shows that it is just retraumatizing people.

I appreciate the insight.

The headache is currently triggered by any usage of my right hand. Anything at all.

And it seems like carrying things was the initial trigger that brought it back. Doesn’t respond to any medications. Concentrated in one spot.

[Lebber]

Originally Posted by WorriedInNYC

I appreciate the insight.

The headache is currently triggered by any usage of my right hand. Anything at all.

And it seems like carrying things was the initial trigger that brought it back. Doesn’t respond to any medications. Concentrated in one spot.

Sounds like a thight trapezius. If so it can be easily corrected. Get yourself checked by a physio. Physcal & psycholocial problems often go hand in hand. Although im almost positive it's ptsd, there is probably something physical that also needs to be adressed. Good luck!

[Lebber]

@woreiedinNYC. Maybe it's interessting to google myofacial pain syndrome and reffered pain patterns from trigger points. Although i strongly recommend a in person physical examination to make sure if and which muscles effected. You can gain some insight on it if you search it. One sided headeaches are a sign of something muscular going on. Physio can help loosen it up again, psycho can help prevent it from happening again because muscular problems often stems from stress (even with physical injuries psychological stress can prevent injuries from healing).